2015~2019年北京市海淀区食源性腹泻患者致泻大肠埃希氏菌型别分布和耐药性分析

目的　分析北京市海淀区食源性腹泻患者致泻大肠埃希氏菌(diarrheagenic Escherichia coli，DEC)的感染状况、型别分布和耐药情况，为致泻大肠埃希氏菌的防控和临床合理用药提供科学依据。方法　对2015~2019年海淀区食源性疾病监测哨点医院送检的1 810份腹泻患者粪便标本直接划线接种在麦康凯培养基上培养，挑取可疑菌落进行生化鉴定、毒力基因测定，对确认为致泻大肠埃希氏菌的菌株进行药敏检测。结果　1 810份粪便标本中检出致泻大肠埃希氏菌214株，检出率为11.8%，各年度的检出率差异有统计学意义（χ2=10.858，P=0.028）。检出的致泻大肠埃希氏菌共有4种型别，其中集聚性大肠埃希氏菌（EAEC）96株（44.9%），产肠毒素大肠埃希氏菌（ETEC）89株（41.6%），肠道致病性大肠埃希氏菌（EPEC）24株（11.2%），肠道侵袭性大肠埃希氏菌（EIEC）5株（2.3%）。在12种抗生素的药敏试验中，70株（32.7%）全部敏感，144株（67.3%）耐药；氨苄西林的耐药率最高（54.7%），其次是四环素（38.8%）和复方磺胺（36.9%），对3种及以上抗生素的多重耐药率为46.3%。结论　北京市海淀区2015~2019年致泻大肠埃希氏菌感染以EAEC和ETEC为主，耐药菌株的多重耐药谱广。应加强对抗生素的使用管理，延缓耐药株的产生和传播。

Type Distribution and Drug Resistance of Diarrheagenic Escherichia coli in Patients with Foodborne Diarrhea in Haidian District,Beijing, 2015~2019

Objective　To analyze the infection status, type distribution and drug resistance of diarrheagenic Escherichia coli from foodborne diarrhea in Haidian District of Beijing, so as to provide scientific basis for prevention and control of Escherichia coli and clinical rational drug use. Methods　1 810 fecal samples of diarrhea patients from Haidian District Foodborne Disease Surveillance Sentinel Hospital from 2015 to 2019 were directly inoculated on McConkey culture medium. The suspicious colonies were selected for biochemical identification and virulence gene determination, and the strains identified as diarrhoeal Escherichia coli were tested for drug sensitivity. Results　214 strains of diarrhoeal Escherichia coli were detected in 1 810 fecal samples, with a detection rate of 11.8%,the difference of detection rate in each year was statistically significant（χ2=10.858，P=0.028）.Four types of diarrhoeal Escherichia coli were detected, including 96 strains of EAEC（44.9%）, 89 strains of ETEC（41.6%）, 24 strains of EPEC（11.2%）and 5 strains of EIEC（2.3%）. In the drug sensitivity test of 12 antibiotics, 70 strains (32.7%) were sensitive, 144 strains (67.3%) were resistant. The resistance rate to ampicillin was the highest (54.7%), followed by tetracycline (38.8%) and compound sulfanilamide (36.9%). The multi resistance rate to three or more antibiotics was 46.3%.Conclusion　EAEC and ETEC were the main diarrheagenic Escherichia coli infections in Haidian District of Beijing from 2015 to 2019，the multidrug resistance spectrum of drug-resistant strains was wide. Should strengthen the use and management of antibiotics to delay the emergence and spread of drug-resistant strains.